Geriatric characteristics and the risk of drug-related hospital admissions in older Emergency Department patients

Key summary pointsAim To investigate (a) the prevalence and clinical manifestations of Drug-Related Admissions (DRAs) and the drugs responsible for these admissions, (b) to study the association between geriatric characteristics and DRAs and c) to study the predictive performance of geriatric screening instrument for identifying DRAs in older patients presenting to the Emergency Department (ED). Findings DRAs are prevalent in older hospitalized patients. Polypharmacy, ADL dependency and a high ISAR or ISAR-HP score are associated with higher risk for a DRA, but the predictive value of geriatric screeners is insufficient and therefore they cannot be used alone to predict for Drug-Related Hospital Admissions in Emergency Department. Message Geriatric screening instruments are not specific and sensitive enough to use alone for identifying drug-related hospital admissions in older patients in the ED. Purpose Drug-Related Admissions (DRAs) are a well-known problem among older patients in the Emergency Department (ED). The aim of this study was (a) to investigate the prevalence and clinical manifestations of DRAs and the responsible drugs, (b) to study the association between geriatric characteristics and DRAs, and (c) to study the predictive performance of geriatric screeners for identifying DRAs in older ED patients. Methods Patients aged >= 70 hospitalized from the ED were included. Demographics, geriatric characteristics and medications were collected. The the Acutely Presenting Older Patient (APOP)-screener, the Identification of Seniors At Risk (ISAR) and the ISAR-Hospitalized Patients (ISAR-HP) were used as geriatric screeners. Potential DRAs were identified retrospectively, the association between geriatric screeners and DRAs was investigated with logistic regression and the predictive performance was assessed by calculating the Area under the Curve (AUC) of the Receiver Operator Characteristics (ROC). Results The mean age of patients was 78 (IQR 73-83), using an average of 6 medications. Out of 240 admissions, 77 (30%) were classified as a DRA. Independent risk factors for DRAs were polypharmacy (OR 2.42; 95% CI 1.23-4.74) and the ADL dependency (OR 1.23; 95%CI 1.05-1.44). ISAR (OR 3.27; 95%CI 1.60-6.69) and ISAR-HP (OR 1.83; 95% CI 1.02-3.27) associated with increased risk of DRAs, whereas the APOP screener did not (OR 1.56; 95% CI 0.82-2.97). The predictive performance of all geriatric screeners for predicting DRAs was poor (AUC for all screeners < 0.60). Conclusion DRAs are highly prevalent in older ED patients. Polypharmacy, ADL dependency and a high ISAR or ISAR-HP are associated with higher risk for DRAs, but the predictive value of geriatric screeners is insufficient.